Abstract
BackgroundCancer of the oral cavity is the sixth most common malignancy reported worldwide and one with the highest mortality rate among all malignancies. There is a paucity of reliable diagnostic methods to detect early malignancies. This study was performed to evaluate the sensitivity and specificity of brush biopsy in identifying oral premalignant and malignant lesions.MethodsOral brush and scalpel biopsies were performed on 85 consecutive patients presenting with an oral lesion deemed to be minimally suspicious by clinical examination and the results were compared.ResultsOf 79 patients with adequate brush biopsy samples with matching scalpel biopsies, 27 revealed histopathologic evidence of dysplasia or carcinoma, 26 of which were independently identified with the oral brush biopsy (sensitivity: 96.3% - 95% CI, 87%-100%). 52 oral lesions did not reveal any histopathologic evidence of dysplasia or carcinoma and of these, brush biopsy reported 47 as "negative" and 5 as "atypical"(specificity of "positive" brush biopsy result is 100%- 95% CI, 93%-100%; specificity for "atypical" brush biopsy result is 90.4%- 95% CI, 82%-97%. The positive predictive value of an abnormal oral brush biopsy was 84% and the negative predictive value was 98%.ConclusionOur study demonstrated that the oral brush biopsy is an accurate test in identifying oral premalignant and malignant lesions, even if minimally suspicious.
Highlights
Cancer of the oral cavity is the sixth most common malignancy reported worldwide and one with the highest mortality rate among all malignancies
In two recent review articles on oral cancer diagnostic aids, Patton et al [16] and Lingen et al [17] concluded that based upon published studies, oral brush biopsy with computer-assisted analysis has been demonstrated to be valuable for detecting dysplasia and cancer when evaluating “clinically suspicious” lesions
Our study indisputably demonstrates that the brush biopsy is as sensitive and specific for evaluating “minimally suspicious” lesions as well as “suspicious” lesions and makes it an effective test to evaluate the entire spectrum of lesions detected during an oral cancer screening examination
Summary
Cancer of the oral cavity is the sixth most common malignancy reported worldwide and one with the highest mortality rate among all malignancies. This study was performed to evaluate the sensitivity and specificity of brush biopsy in identifying oral premalignant and malignant lesions. One major problem inherent in current oral cancer screening is that visual inspection often cannot differentiate between lesions harboring dysplasia and/or early cancer from those that do not. This is especially true for innocuous looking lesions which are subjected to “watchful waiting” and close follow-up despite the fact that some precancerous and cancerous cells within them remain undetected and are allowed to progress to a more advanced stage [5]. The practice of not properly evaluating all suspicious lesions, that is, lesions without a specific etiology such as trauma or infection, invariably results in delay of the correct diagnosis, limiting treatment options
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